Background: As rhinoplasty techniques have become more complex, surgeons often need more than what septal or conchal cartilage can provide. While costal cartilage became more popular for that reason, some surgeons are still uncomfortable with its invasiveness and donor site morbidity. Here, we used lyophilized allogeneic costal cartilage for septorhinoplasty and investigated its safety and usefulness. Methods: The costal cartilage was harvested from a cadaveric donor and treated via multiple steps, including defatting and lyophilization, to remove all viable cells and antigenicity. The cartilage was then stored at room temperature and rehydrated 24 hours before use. Lyophilized cartilage allografts were used in 20 patients. Three types of septal graft were performed — spreader, batten, and extension — to correct septal or columellar deviation and enhance the nasal tip. Results: The mean follow-up period was 4.3 years. In all cases, the graft successfully met the rhinoplasty purpose. No significant deformation was detected in any of the patients. Although warping was observed in one patient (5%), there was no case of clinical infection, extrusion, or graft removal and no revisional surgery for an unfavorable aesthetic result. Conclusions Lyophilized allogeneic cartilage was used for septorhinoplasty very safely and effectively. It can be carved into any shape and has all other properties required for perfectly replacing autologous costal cartilage. The main advantage of cartilage allografts is a limitless supply of high-quality cartilage without donor site morbidity. The disadvantages include the need for special facilities and manpower and extra covering cost.

The purpose of this study was to devise an expanded ischemic flap model and to investigate the role of AMD-3100 (Plerixafor, chemokine receptor 4 inhibitor) in this model by confirming its effect on mobilization of stem cells from the bone marrow. Male Sprague-Dawley rats were used as an animal research model. The mobilization of stem cells from the bone marrow was confirmed in the AMD-3100-treated group. The fractions of endothelial progenitor cells (EPC) and the vascular endothelial growth factor receptor (VEGFR) 2+ cells in the peripheral blood were increased in groups treated with AMD-3100. The expression of vascular endothelial growth factor (VEGF) was increased in response to expansion or AMD injection. The expression of stromal cell derived factor (SDF)-1 and VEGFR2 were increased only in unexpanded flap treated with AMD-3100. Treatment with AMD-3100 increased both the number and area of blood vessels. However, there were no statistically significant differences in the survival area or physiologic microcirculation in rats from the other groups. This endogenous neovascularization induced by AMD-3100 may be a result of the increase in both the area and number of vessels, as well as paracrine augmentation of the expression of VEGF and EPCs. However, the presence of a tissue expander under the flap could block the neovascularization between the flap and the recipient regardless of AMD-3100 treatment and expansion.
Animals ; Anti-HIV Agents/pharmacology ; Bone Marrow Cells/cytology ; Chemokine CXCL12/biosynthesis ; Endothelial Progenitor Cells/*cytology ; Hematopoietic Stem Cells/*cytology ; Heterocyclic Compounds/*pharmacology ; Hypoxia-Inducible Factor 1, alpha Subunit/metabolism ; Male ; Neovascularization, Physiologic ; Nitric Oxide Synthase Type III/metabolism ; Rats ; Rats, Sprague-Dawley ; Receptors, CXCR4/antagonists & inhibitors ; Surgical Flaps/*blood supply/surgery ; Tissue Expansion/*methods ; Vascular Endothelial Growth Factor A/biosynthesis ; Vascular Endothelial Growth Factor Receptor-2/biosynthesis/metabolism

PURPOSE: A chemotherapy response assay test is performed to evaluate the degree of tumor growth inhibition by a chemotherapeutic agent. Several studies have been done on its usefulness; however, to the best of our knowledge, only a few studies concerning the relationship between chemotherapy response assay test results and breast cancer patients' prognoses have been conducted. Thus, we performed this study to analyze this relationship. METHODS: Among breast cancer patients who underwent curative surgery and neoadjuvant or adjuvant chemotherapy between August 2004 and December 2009, 102 were enrolled in this study. Chemotherapeutic regimens for patients were doxorubicin plus taxane or doxorubicin plus cyclophosphamide followed by taxane. We divided these patients into two groups (sensitive group [n=19] and resistant group [n=83]) and analyzed the relationship between chemosensitivity results and patient prognosis. RESULTS: The sensitive group was associated with poor disease-free survival (DFS) (p=0.003) and overall survival (OS) (p<0.001). No significant differences were observed in tumor histology (p=0.548), tumor size (p=0.479), number of metastatic lymph nodes (p=0.326), histologic grade (p=0.077), or nuclear grade (p=0.216) between the two groups. However, in respect to molecular subtype, the HER2-positive type and triple negative breast cancer were more frequently observed in the sensitive group (p=0.001). In a univariate and multivariate analysis for DFS, doxorubicin sensitivity was significantly associated with a poor prognosis (p<0.05). CONCLUSION: Better chemosensitivity results are associated with a poor prognosis in breast cancer patients who have undergone anthracycline- and taxane-based chemotherapy, however, examination of additional cases and the use of a longer study period are needed.
Breast ; Breast Neoplasms ; Bridged Compounds ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Humans ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Taxoids

PURPOSE: There are several surgical methods for correcting a velopharyngeal insufficiency (VPI) but in some cases, it is not possible to achieve complete recovery of the velopharyngeal function. This paper introduces a new therapy for treating hypernasality without further surgery using continuous positive airway pressure (CPAP). METHODS: CPAP therapy was applied to seven VPI patients for eight weeks from April of 2007 to September of 2009. All patients underwent palatoplasty for the cleft palate and six patients underwent palatal lengthening for VPI before CPAP therapy. A speech pathologist performed an auditory perceptual evaluation to evaluate the improvement in hypernasality after 8-week CPAP therapy. RESULTS: Six patients showed an improvement in hypernasality after CPAP therapy according to the auditory perceptual evaluation. One patient with severe hypernasality responded to the early part of therapy but the hypernasality did not improve after therapy. CONCLUSION: CPAP therapy might be effective in reducing the hypernasality in patients with VPI by providing resistance training to strengthen the velopharyngeal closure muscles. In particular, CPAP therapy could be more effective for patients who show mild to moderate hypernasality after surgery.
Cleft Palate ; Continuous Positive Airway Pressure ; Humans ; Muscles ; Resistance Training ; Velopharyngeal Insufficiency

BACKGROUND: To date, there are few data on the risk factors for severe cases and deaths associated with the 2009 pandemic H1N1 influenza A. Here, we describe the clinical and epidemiologic characteristics of patients hospitalized for pneumonia and identify those factors associated with the development of major complications (MC). METHODS: We reviewed the medical records of 41 cases of pneumonia admitted to a university-affiliated tertiary hospital between Aug 26 and Dec 10, 2009, and who had confirmed H1N1 influenza A based on real-time reverse transcriptase-polymerase-chain-reaction assay. There were 7,962 patients that fit these criteria. We compared the clinical features and demographic characteristics of patients who developed MC to with those who did not develop MC. RESULTS: During the study period, 10 patients developed MC (required admission to the intensive care unit, n=10; required ventilator therapy, n=6; death, n=4). Patients with MC were significantly older than those without MC and more frequently had underlying medical conditions (90.0% vs 41.9%, p-value <0.01). In the patients with developed MC, the median PaO2/FiO2 ratio of 230.0 (145.0~347.3) at admission and pneumonia severity index (PSI) score of 141.5 (88.3~158.5) were higher than patients without MC. However, no differences were observed in laboratory findings or in viral shedding between the 2 groups. CONCLUSION: In hospitalized pneumonia patients of 2009 H1N1 influenza, old age, a history of malignancy, initial hypoxemia, PaO2/FiO2 ratio, and PSI score appear to be risk factor significantly related to developing MC. These findings might be the basis to influence strategies for admitting patients to an intensive or intermediate care unit and for pre-emptive antiviral therapy.
Anoxia ; Critical Illness ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Intensive Care Units ; Medical Records ; Pandemics ; Pneumonia ; Risk Factors ; Tertiary Care Centers ; Ventilators, Mechanical ; Virus Shedding

PURPOSE: The prevalence rate of the BRAF mutation in papillary thyroid cancer (PTC) is as high as about 52 to 83% in Korea. Preoperative detection of BRAF mutation on fine needle aspiration cytology (FNAC) slides may help the surgeon make better therapeutic decisions. The present study aims to assess the feasibility of the mutant allele specific amplification (MASA) and restriction fragment length polymorphism (RFLP) method with using conventional FNAC slides and we also wanted to evaluate the clinical role of preoperatively detecting BRAF mutation. METHODS: We extracted the genomic DNA from 59 FNAC slides and performed direct sequencing (DS) for detecting BRAF mutation. We could use only 17 slides for the MASA method and 6 slides for the RFLP method due to the shortage of extracted DNA. Additionally, we retrospectively analyzed the cases for which a histological diagnosis could be made. RESULTS: Genomic DNA was extracted from 23 out of the 59 FNAC slides. The BRAF mutation status could be assessed via DS in 33 out of the 59 FNAC slides. The concordance between the MASA method and DS and the RFLP method and DS was 36.3% and 66.7% respectively. The positive and negative predictive value of the 13 indeterminate nodules was 87.5% and 20%, respectively. We could not find any association between the BRAF mutations and the alleged risk factors of PTC. CONCLUSION: We believe that the purity and the amount of the DNA template must be increased to detect BRAF mutation with using a FNAC slide. Preoperative detection of the BRAF mutation on a FNAC slide may refine the cytological diagnosis, but the application of assessing BRAF mutation as a prognostic marker is debatable.
Alleles ; Biopsy, Fine-Needle* ; Diagnosis* ; DNA ; Korea ; Methods ; Polymorphism, Restriction Fragment Length ; Prevalence ; Retrospective Studies ; Risk Factors ; Thyroid Gland* ; Thyroid Neoplasms*

Surgical site infection is one of the most common hospital infections and surgical complications. Appropriate administration of prophylactic antibiotics is, therefore, important to reduce surgical site infection rate. The use of prophylactic antibiotics in Korea tends to be too long and clinical confirmation of safe reduction of oral antibiotics use is mandatory. This is a preliminary report on the results of reducing oral antibiotics from 5 to 2 days in clean plastic surgery patients. Patients who underwent clean operation under local anesthesia between June 2008 and December 2008 were included in this study. The patients were divided into two groups, and they received oral antibiotics for 2(group O2) or 5(group O5) days. Complication rates, related expenses, and patients' complaints regarding the medication were compared between the two groups, considering the intravenous antibiotics use. There was no significant systemic or infection-related complication. An overall complication rates were 2.8% in group O2, 4.8% in group O5. All the complications were regional and required no surgical intervention. There were no significant differences between total(p=0.72), intravenous antibiotics administered patients(p=0.08), and intravenous antibiotics non-administered patients(p=1.00). Oral antibiotics could safely be reduced to 2 days in clean plastic surgery excluding intravenous antibiotics.
Anesthesia, Local ; Anti-Bacterial Agents ; Cross Infection ; Humans ; Korea ; Surgery, Plastic ; Surgical Procedures, Operative

PURPOSE: The most widely accepted protocol for alveolar cleft reconstruction is to repair it during the mixed dentition stage. There were lower resorption rate (about 88%) at this stage. However we found some cases that need repeated bone grafting. Therefore we sought to analyze the cause of repeated alveolar bone grafting in connection with other factors. METHODS: From January 2000 to January 2006, thirty-nine secondary alveolar bone grafts with iliac crest spongiosa were carried out. In 39 patients, 5 patients who had significant bone graft resorption received repeated alveolar bone graft. In all the cases, the causes of repeated bone grafts were dental root exposure(angulation), and the deficiency of the bony support for lateral incisor or canine eruption. In 3 cases, there was deficiency of the alveolar bone at the cleft side. There was the need of repeated bone grafts for orthodontic treatment in 2 cases and for application of dental implants in 1 case. RESULTS: During the follow-up period, the clinical and radiologic examinations showed that repeated alveolar bone grafts were maintained successfully without any complications. The volume of the repeated bone graft was sufficient for orthodontic treatment and implantation. CONCLUSION: The essential conditions for successful alveolar bone grafting includes the status of cleft sided teeth, further treatment and planed schedule, as well as canine eruption. Alveolar bone grafting has to be performed with difference of each case in mind.
Appointments and Schedules ; Bone Resorption ; Bone Transplantation ; Child ; Dental Implants ; Dentition, Mixed ; Follow-Up Studies ; Humans ; Incisor ; Tooth ; Transplants

PURPOSE: The jejunal free flap has the shorter ischemic time than other flap and requires a laparotomy to harvest it. As the evaluation of the perfusion the buried flap is very important, the perfusion of the buried jejunal free flap requires monitoring for its salvage. We tried to improve the monitoring flap method in the jejunal free flap and examined its usefulness. METHODS: From March 2002 to March 2006, the monitoring flap method was applied to 4 cases in 8 jejunal free flaps for the pharyngeal and cervical esophageal reconstructions. The distal part of the jejunal flap was exposed without suture fixation through cervical wound for monitoring its perfusion. The status of perfusion was judged by the color change of jejunal mucosa and mesentery. If necessary, pin prick test was performed. Doppler sonography was applied to mesenteric pedicle of the monitoring flap in case of suspicious abnormal circulation. RESULTS: The monitoring flap shows no change in 3 cases, but the congestion happened in one case at the 12 hours after the operation. This congestion was caused by the twisting or kinking of the mesenteric pedicle of the monitoring flap. So, we fixed up the monitoring flap close to adjacent cervical skin for prevention of rotation. Finally, the main part of transferred jejunal flap was intact. CONCLUSION: The success of a jejunal free flap depends on close postoperative monitoring and early detection of vascular compromise. So, various monitoring methods have been tried, for instance, direct visualization using a fiberoptic pharyngoscope, through a Silastic window placed in the neck flap, or external surface monitoring with an Doppler sonography, use of a buried monitoring probe. But, all of the above have their own shortcomings of simplicity, non-invasiveness, reliability and etc. In our experience, monitoring flap can be a accurate and reliable method.
Estrogens, Conjugated (USP) ; Free Tissue Flaps* ; Laparotomy ; Mesentery ; Mucous Membrane ; Neck ; Perfusion ; Skin ; Sutures ; Wounds and Injuries

PURPOSE: Cardiovascular risk assessment of atherosclerotic arterial occlusive diseases is a critical component of preoperative care. Many indexes have been developed to help identify patients at high risk for perioperative cardiac events. We sought to study guideline implementation and clinical outcomes in cardiovascular risk assessment. METHOD: We studied 75 patients who underwent preoperative cardiac risk assessment between 2003 and 2006 at the Kyung Hee University Medical Center. The American College of Cardiology/American Heart Association (ACC/AHA) guidelines were used to stratify the patients. RESULT: The mean age of patients was 67.9 years. When stratified into risk categories according to the ACC/AHA guidelines, 2 patients was high risk group, 51 intermediate risk group, and 22 low risk group. There were 3 perioperative cardiac complications (4.0%) including 2 mortalities (2.7%). There was a trend toward a higher frequency of cardiac complications when there was discordance with the ACC/AHA guidelines, but there was no significant difference (discordance 7.1%, concordance 0%, P=0.251). The guidelines recommended cardiac testing for 44 patients, but 12 patients (27.3%) were tested. The guidelines did not recommend for 31 patients, but additional cardiac tests were done for 10 patients (32.3%) and mainly associated with low risk group. CONCLUSION: Differences between clinician practice and guideline recommendations existed and did not result in a higher frequency of cardiac complications.
Academic Medical Centers ; Arterial Occlusive Diseases* ; Heart ; Humans ; Mortality ; Preoperative Care ; Risk Assessment*